Global Health and Physician ResponsibilityVIERA WARDHANI

Meet your new partner Viera Wardhani

Department of Public Health, FKUB

Postgraduate Program in Hospital Management

Why?

We all live in the same word

We are all member of a single humanity inside our heart we all speak the same, we all love our children and our parents, we all live in the same world…….(Mac Forne Malne)

We all live in the same world

If civilization is to survive we must cultivate the science of human relationship the ability of all people all kind to live together in the same world at peace (Franklin D Rosevelt)

Global Health Challenges

Tujuan Pembelajaran

Menjelaskan isi MDG dan Post MDG yang terkait dengan bidang kesehatan

Menyebutkan indikator dan target pencapaian MDG dan Post MDG yang terkait dengan bidang kesehatan

Menjelaskan pencapaian indikator dan target pencapaian MDG bidang kesehatan di Indonesia dibandingkan dengan negara ASEAN

Menjelaskan permasalahan dalam pencapaian indikator dan target pencapaian MDG bidang kesehatan

Mengidentifikasi peran dokter dalam sistem pelayanan kesehatan untuk menjamin pencapaian MDG dan agenda post MDG

Menjelaskan tantangan AFTA 2015 dan UHC dalam bidang kesehatan dan peran aktif dokter.

What is MDG and current state achievement

Topic 1-2

Why MDG

What is MDG

4. Reducing Child Mortality

Indicator 1997 Target 2007 Comments

Under five mortality rate/1000

81 32 40

Infant mortality rate/1000

57 19 32

Child Mortality Health

Neonatal death causes

Infant mortality causes

U-5 Mortality causes

5. Improving maternal health

Indicator 1990 Target 2007 Comments

Maternal mortality rate per 100.000

390 110 300

Birth helped by trained nurse

40.7% 100% 72.4

Married women age 15-49 using contraception

50.5% 100% 57.9

MMR Trend

Cause MMR

Three delay model

Making Pregnancy Safer Messages

All pregnancy is intended (wanted)

All delivery is helped by trained health care attendance

All pregnancy complication

managed with an adequate health

1

2

3

6. Combating HIV/AIDS and other Diseases (TB, Malaria)

Indicator 1997 Target 2007

Prevalence of HIV/AIDS

Control the spread

5.6

Case of Malaria/1000

8.5

Tuberculosis prevalence /100.000

786 262

Why HIV Epidemic?

PerempuanLaki-laki

3,1 Juta Pria membeli Sex

(2-20% dari Pria Dewasa)

1,6 Juta menikah

dg pria risiko tinggi

230.000penasun

800,000GWL

230,000Wanita

Pekerja seks

Anak-anak

Jumlah Penduduk Indonesia: 240 juta

ASEAN Human development index Rank

Country ASEAN rank

HDI Income category

GDP

Group Rank Index

Singapore High High 25 0.992 High 29.663

Brunei High High 30 0.894 High 28.161

Malaysia Upper med High 63 0.811 Upper med 10.882

Thailand Upper med Medium 78 0.781 Lower med 8.672

Philippine Medium Medium 90 0.711 Lower med 5.137

Vietnam Medium Medium 105 0.733 Low 3.071

Indonesia Medium Medium 107 0.738 Lower med 3.843

Laos Lower med Medium 130 0.601 Low 2.039

Cambodia Lower med Medium 131 0.598 Low 2.727

Myanmar Lower med Medium 132 0.583 Low 1.027

ASEAN Human development index Rank

Thai Mal Phil Indo Vietn. Cam Lao Myan.

Poverty A A A ?

Hunger A A A

Primary education

A A

Gender disparity

A A A

Under 5 M A A

MMR A A

HIV/AIDS A A

Infectious disease

A A

Environment ? ?

Safe water, sanitation

A A A

What are the remaining global problems?SUSTAINABILITY AND GOOD GOVERNANCE

From MDGs to Sustainable Development Goals

8 GOALS MDGs

12 GOALS SDGs

Comparing MDGs and SDGs

MDGs 2000 - 2015

1. Menanggung Kemiskinan dan Kelaparan

2. Mencapai Pendidikan dasar untuk semua

3. Mendorong Kesetaraan Gender dan Pemberdayaan Perempuan

4. Menurunkan Kematian Anak

5. Meningkatkan Kesehatan Ibu

6. Mengendalikan HIV dan AIDS, Malaria & Penyakit Menular Lainnya (TB)

7. Menjamin Kelestarian Lingkungan Hidup

8. Mengembangkan Kemitraan Pembangunan Tingkat Global

POST 20151. Mengakhiri Kemiskinan

2. Memberdayakan Anak Perempuan, Kaum Perempuan & Pencapaian Kesetaraan Gender

3. Meningkatkan Mutu Pendidikan & Penerapan Belajar Seumur Hidup

4. Menjamin Hidup Sehat

5. Menjamin Ketahanan Pangan & Gizi Baik

6. Menjamin Tersediannya Akses Air Bersih & Sanitasi

7. Membangun Ketahanan Energi Berkelanjutan

8. Menciptakan Lapangan Kerja, Penghidupan Berkelanjutan, & Pertumbuhan Berkeadilan

9. Mengelola Aset Sumber Daya Alam secara Berkelanjutan

10. Meningkatkan Penyelenggaraan Pemerintahan yang baik dan efektif

11. Menjamin Kehidupan Bermasyarakat yang Aman dan Damai

12. Menciptakan Lingkungan Global yang Kondusif sebagai Katalisator Pembiayaan Jangka Panjang

Two Important Keys

Good governance

Sustainability

AFTA Challenges and Universal Health Coverage

AFTA challenges

Global Standard

Free Trading

Global Competition

Universal Health Coverage & Sustainable Development

Health enables sustainable development

Health is a Right

Health is socially determined

Health contributes to growth & development

Increase access to health services

Improve level & distribution of

health

Outcomes

Better health for citizen

Improve country competitiveness

Inclusive & sustainable growth

Healthy population mean higher labor productivityHigher return to household from labor market participation

75% of health outcome is highly depend on working and living condition

The right of everyone to enjoy the highest attainable standard of physical and mental health is globally recognized

The contribution of health sector

Post 2015 Development Agenda : Wellbeing for All

Sustainable wellbeing for all: poverty eradication, education, nutrition, environment, security, etc

Healthy lives at all stages: child survival, maternal survival, MDG6, adolescent health NCD burden reduction

Universal Health Coverage; health promotion, prevention, treatment, financial risk protection

Health Sector

Other Sector

UHC Means

All people can access the health service they need without incurring financial hardship

AccessFinancial protection

Road map of Indonesian universal health coverage

(UHC)

20% 50% 75% 100%

20% 50% 75% 100%

10% 30% 50% 70% 100% 100%

`Perusahaan 2014 2015 2016 2017 2018 2019

USAHA BESAR 20% 50% 75% 100% USAHA SEDANG 20% 50% 75% 100% USAHA KECIL 10% 30% 50% 70% 100% USAHA MIKRO 10% 25% 40% 60% 80% 100%

2012

2013

2014

2015

2016

2017

2018

2019

Pengalihan Peserta JPK Jamsostek, Jamkesmas, Askes

PNS, TNI Polri ke BPJS Kesehatan

Perluasan Peserta di Usaha Besar, Sedang, Kecil & MikroPenyusunan Sisdur

Kepesertaan dan

Pengumpulan Iuran

Pemetaan Perusahaa

n dan sosialisasi

Pengukuran kepuasan peserta berkala, tiap 6 bulan

Integrasi Kepesertaan Jamkesda dan askes komersial ke BPJS Kesehatan

Pengalihan Kepesertaan TNI/POLRI ke

BPJS Kesehatan

Kajian perbaikan manfaat dan pelayanan peserta tiap tahun

Sinkronisasi Data Kepesertaan: JPK

Jamsostek, Jamkesmas dan Askes PNS/Sosial -- NIK

Penduduk yang dijamin di berbagai skema 148,2 jt jiwa

111,6 juta peserta dikelola BPJS Keesehatan

60,07 Juta pst dikelola oleh Badan Lain

257,5 juta peserta (semua

penduduk) dikelola BPJS Keesehatan

Tingkat Kepuasan

Peserta 85%

KEGIATAN: Pengalihan, Integrasi, Perluasan

73,8 juta belum jadi peserta

90,4juta belum jadi peserta

Perpres Dukungan

Operasional Kesehatan bagi

TNI Polri

86,4 juta PBI

3572%

(2013)

National Health Security System

Regulator

BPJS

Participants

Health facilities

Paym

ent p

reem

ie M

edica

l ser

vices M

OU

Claim order

Claim paym

entAccess to Health service

Health Services

National policy for regulation and implement

Regulation for , health personal, medical equipment,

medicine formularies etc.

Regulasi Pricing of health services/provider (TARIF)

Kendali

Bia

ya &

kualit

as

Yanke

s

Government

Sistem Rujukan

Pembayar tunggal, regulasi, kesetaraan

PrimarySecondary Referral

Tertiary Referral system

2014 20202015 2019

Keep in mind